The Academy of Medical Sciences Review 2006 FMedSci Contents

1 The Academy’s objectives and ambitions for medical science 2 A message from our President 4 Executive Director’s report 6 The strength of our Fellowship 8 How we work 10 Progress through partnership 12 Celebrating science 14 Advancing medical science and infl uencing policy 16 Building trust in science 18 Working in partnership with industry 20 The impact of research 22 Creating the next generation of medical scientists 24 Financial information 25 The Academy offi ce

14 16 18 20 22 The Academy’s objectives and ambitions for medical science

The Academy of Medical Sciences promotes advances in medical science and campaigns to ensure these are converted as quickly as possible into healthcare benefi ts for society. Our 850 Fellows are the UK’s leading medical scientists from hospitals and general practice, academia, industry and the public service.

Our Fellows are central to all we do. The excellence of their science, their contribution to medicine and society and the diversity of their achievements are refl ected throughout this review.

The Academy seeks to play a pivotal role in determining the future of medical science in the UK, and the benefi ts that society will enjoy in years to come. We champion the UK’s strengths in medical science, including the unique opportunities for research aff orded by the NHS, encourage the implementation of new ideas and solutions – often through novel partnerships, promote careers and capacity building and help to remove barriers to progress.

Throughout all our work the Academy strives to demonstrate our key attributes of excellence, independence, leadership, diversity and fl exibility.

Modern medicine requires a multi-disciplinary approach – both in research and in the formation of public policy. The Academy off ers an integrated and independent national resource with the expertise and authority to deal with public policy issues in healthcare in their widest scientifi c and societal contexts.

As we approach our tenth anniversary we have clear goals to guide our work, and a well-researched and considered programme to reach our objectives. At the heart of our strategy for the next fi ve years are these objectives:

1. To encourage the pursuit of internationally competitive medical science and the translation of that knowledge, and its associated technologies, from the laboratory bench to the delivery of healthcare. 2. To infl uence the development and implementation of national policy in matters of medical science and healthcare. 3. To engage with the public to build confi dence in the practice of medical research and to address public concerns. 4. To attract and develop the brightest individuals to careers in biomedical science. 5. To contribute to developments and improvements in global health.

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 1 A message from our President

As my term of offi ce draws to a close I refl ect on how much has changed during Professor Sir Keith Peters the Academy’s short life. I have no doubt that UK science in general, and medical FRS PMedSci science in particular, is now healthier than it was a decade ago. In the wake of John Bell’s report Strengthening Clinical Research, the creation of the UKCRC and the Walport report1 on clinical academic careers are major gains for our community.

There is now a general recognition by government of the strategic importance of medical science to the UK, as a contributor to the health of our citizens and others, especially in the developing world, and as key to the success of our health-related industries, notably pharma, biotechnology and medical equipment. The Academy’s focus on translating medical science into clinical benefi t puts us at centre stage of national policy debates.

The Academy welcomed the review of UK health research funding undertaken by Sir David Cooksey and supported the underlying principle of creating a holistic UK health research and development system with the appropriate leadership, governance, resources and culture. No other country enjoys the outstanding opportunity for clinical research represented by the NHS which, if its potential is realised, off ers an unparalleled advantage for UK plc. However this optimism must be guarded. The shift towards the delivery of healthcare by the private sector, with no duty to support teaching and research, represents a risk that may deny UK academic medicine this major competitive advantage.

The Academy is in good shape. We have a small but outstanding team at 10 Carlton House Terrace and I know that everyone who has worked with them will join me in expressing great thanks for everything they do. As President, I have had excellent support from my colleagues on the Academy’s Council. I want to express my particular appreciation to Colin Dollery, who stood down as Treasurer in 2005, and to Patrick Vallance who served as Registrar until July 2006.

I hand over to John Bell with my enthusiasm for the work of the Academy undiminished. I believe we have fulfi lled the brief set out for us by the Academy’s founder President, Peter Lachmann, to become the leading voice for academic medicine in the UK. Eight years ago the Academy did not exist. It is hard now to imagine medical science without it.

1 Medically and dentally qualifi ed academic staff : Recommendations for training the researchers and educators of the future. Published by the UKCRC and MMC March 2005.

2 THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 3 Executive Director’s report

For the Academy of Medical Sciences, now eight years old, success has come in many guises: the number of published policy studies and their evident impact on UK national healthcare policy, the election of excellent medical scientists to the Fellowship from across the academic spectrum, the development of forceful and eff ective strategic partnerships throughout the scientifi c community and the continued expansion of the Academy’s operations, together with an enhanced reputation nationally and internationally. We – the Fellows, Offi cers, Council and staff – have worked hard to achieve this. In this document I have the pleasure of highlighting specifi c achievements and thanking the very many people who have given their time and expertise to the Academy. I would also like to thank our many generous donors and sponsors. Their commitment to the promotion of medical science for public benefi t, and their support for the work of this Academy, has been invaluable. Mrs Mary Manning Executive Director

Mrs Mary Manning Public policy in medical science and Testing antibody therapies, an independent Executive Director healthcare commentary on the scientifi c issues raised by The Academy is playing an increasingly pivotal role the TGN1412 clinical trial (April 2006); and an in the formulation of policy and funding decisions international symposium, with speakers drawn that underpin academic medicine in the UK. Two from the USA, Canada, Australia and Europe years ago we took a strategic decision to broaden in June 2005 to examine the socio-economic the Fellowship in order to expand the breadth benefi ts of medical research. This resulted in the of expertise and thus we have elected lawyers, publication Medical research: assessing the benefi ts science writers, ethicists, mathematicians, industrial to society (June 2005). chemists and economists to the membership. Much of the public policy debate over the In addition we have actively sought strategic autumn and winter of 2005 was dominated by partnerships that cut across traditional disciplinary the possibility of an infl uenza pandemic. boundaries to promote and champion key policy A private meeting for Fellows with the Chief issues. The success of this strategy is evident from Medical Offi cer, Sir Liam Donaldson FMedSci, the comments of colleagues on page 10. was convened for the purpose of improving UK In the past two years, the Academy has addressed preparedness in the face of such a threat, and the a number of major policy issues with profound discussion contributed to our response to the societal implications: Safer Medicines (November House of Lords Science and Technology Select 2005), produced by experts drawn from industry Committee inquiry into ‘Pandemic Infl uenza’. and academe; Personal data for public good: using This is also the subject of a joint study with the health information in medical research (January Royal Society Pandemic infl uenza: science to policy 2005), highlighting the vital role of patient data in (November 2006). contributing to scientifi c advances in healthcare;

4 The recent formation of the All Party Parliamentary The Academy has continued to oversee and support Group on Medical Research has provided a forum for the progress of the Fellows funded by The Health sharing advice and information with MPs and Peers. Foundation, the Allgemeines Treuunternehmen The Academy’s 2005 work on the Mental Capacity Foundation and the Primary Immunodefi ciency and Human Tissue Bills illustrated the benefi ts of Association. In 2005, the non-clinical careers using Fellows to provide evidence in support of policy committee, chaired by Professor Keith Gull FRS positions and of initiating strategic collaborations FMedSci, undertook a review of non-clinical research with other organisations; in these instances the MRC, fellowships in the biomedical sciences, The Freedom Wellcome Trust, Cancer Research UK, Association of to Succeed (July 2005). The report has already made an Medical Research Charities and the Royal College of impact on the policies of major funders. Physicians. The Academy offi ce From time to time the Academy undertakes specifi c The staff , only 12 in number, bring considerable commissions from government. ‘Brain science, talent and energy to the work of the Academy. Their addiction and drugs’, was commissioned by the dedication, commitment and willingness to take Department of Health in August 2005. This project is on increasingly demanding activities underpin our supported by the Offi ce of Science and Innovation success. We are grateful for the generous support with funds to cover a major exercise in public dialogue, of the British Academy in whose building we reside. which we welcome. This new policy study, chaired by We bade farewell to our Treasurer Sir Colin Dollery Sir Gabriel Horn FRS, will report in 2007. FMedSci who retired from offi ce in 2005 and Registrar Professor Patrick Vallance FMedSci in July 2006. Both Industry Forum brought a strong reforming agenda to the Academy Collaboration with industry is one of the many and inspired many novel activities. crosscutting themes that pervade the Academy’s work. It is also addressed through the Industry Forum, The Academy’s President, Sir Keith Peters FRS PMedSci, which brings together biomedical scientists from will stand down in November 2006. Only the second academe and industry and currently has 28 active President in our short history, Keith has successfully members. Dr Tim Rolph, Discovery Site Head, Pfi zer, led the Academy to its current position as a leading delivered the 2006 Forum lecture: The human genome, advisor to the country on medical science issues. The realising pharmaceutical opportunities. A symposium on Academy has greatly benefi ted from his considerable Experimental Medicine in April 2006 also explored the experience, shrewd judgement, and sound advice. potential of experimental medicine to enable a better The future understanding of human disease, its diagnosis and A new 5-year strategic plan was published in June prognosis, and therapeutic interventions. 2006 reaffi rming the Academy’s commitment to Education, training and research the promotion of advances in medical science A strong cadre of scientists and clinicians is critical for society. Two new goals were identifi ed: the to ensuring that the UK continues to engage in the potential for the Academy to look beyond the UK highest quality research and teaching at national and and Europe to contribute to the development of international levels. A Department of Health grant global health, and the need to engage with the has enabled the Academy to develop a mentoring public to build confi dence and participation in the programme to assist Clinician Scientist Fellows with practice of medical research. The Academy has already their personal and professional development and the built strong links throughout Europe thanks to its Academy’s expertise and strong reputation in this involvement in the work of the Federation of European area has attracted interest from other funding bodies. Academies of Medicine; the inclusion of global health Work on our dedicated careers website has continued in the strategic plan represents a signifi cant expansion throughout the year. of Academy eff ort.

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 5 The strength of our Fellowship

Academy Fellows are selected primarily for their outstanding contribution to the advancement of medical science, for their innovative application of existing science knowledge, or for their conspicuous service to medical science and healthcare.

The diversity of their talent and expertise ensures that the Academy is excellently placed to bring authoritative opinion and practical guidance to complex issues in medical science and healthcare. The breadth and depth of this expertise is illustrated in these profi les of eight new Fellows, some of the 80 admitted during 2005 and 2006.

Janet Darbyshire’s work has had a major Polly Roy is Professor of Virology at the London impact on global health, particularly through School of Hygiene and Tropical Medicine. Her her involvement in the design and execution of research on the structure and biology of multi- clinical trials and epidemiological studies in TB, shelled viruses and emerging infectious diseases HIV and AIDS. Professor Darbyshire’s work in the has had a signifi cant impact on healthcare and UK and in the developing world has established economics. Professor Roy instigated the fi rst her as one of the world’s leading epidemiologists. complete examination of a distinct group of She had a leading role in the development of viruses, called orbiviruses, at the molecular level, the National Cancer Research Network (NCRN), a fi eld she pursues to the present day. The work which has led to a marked increase in recruitment has identifi ed the structures and enzyme activities to clinical trials to improve the management of necessary for virus success and has opened the cancer in the UK. Since 2005 she has been Co- way to improved diagnosis, vaccines and more director of the UK Clinical Research Network. She eff ective drug design for viruses of both human is also Director of the MRC Clinical Trials Unit and and animal origin. Professor of Epidemiology at University College London. Neil Ferguson, Professor of Mathematical Biology at Imperial College London, has made a major Shoumo Bhattacharya, Professor of contribution to our understanding of how new Cardiovascular Medicine at the University of diseases spread and the potential risks they pose to Oxford, has applied the skills of molecular and human and animal populations. In 1996, Professor cell biology to increase our understanding of Ferguson developed the fi rst back-calculation congenital heart disease (CHD). CHD is a major model of the BSE epidemic, and has since built cause of morbidity and death in childhood in the a major reputation in the real-time modelling West. Professor Bhattacharya led the team that of epidemics. His mathematical models played used a number of innovative approaches, such a major role in shaping the scientifi c advice to as MRI imaging, to identify genes and proteins government during the foot and mouth epidemic where mutations can result in congenital heart of 2001. More recently, his research has been used malformations, and established a link between by governments across the world in preparing for CHD and left-right patterning. His work has led to a possible new fl u pandemic. He also works on a new understanding of these diseases at the level new variant CJD, bioterrorist agents and pathogen of clinical and molecular genetics. evolution.

6 Thomas Jessell of Columbia University Medical Alexander McCall Smith is Emeritus Professor (Clockwise from top left) Centre is one of a number of Academy Fellows of Medical Law at the University of Edinburgh. In Janet Darbyshire OBE FMedSci based at leading medical research establishments addition to being an internationally renowned Shoumo Bhattacharya FMedSci overseas. Professor Jessell’s work on the spinal cord author he is one of the world’s leading medical Polly Roy FMedSci has defi ned the key mechanisms that specify the lawyers and an outstanding scholar in the fi elds of Alexander McCall Smith FRSE identity of neurons, the patterning of their axonal law and medical ethics. Much of his research has FMedSci projections, and the formation of selective synaptic been concerned with exploring the medico-legal Sir Gregory Winter CBE FRS connections. His current portfolio includes research aspects of criminal law but, unusually for a British FMedSci into the development of neural circuits for simple lawyer, since countries’ legal systems diff er widely, Rosalind Smyth FMedSci refl ex behaviour. Professor Jessell’s fi ndings have his work has been acclaimed internationally and had profound implications for scientists’ ability to applied in many parts of the world, particularly in Neil Ferguson OBE FMedSci direct the generation of motor neurons from stem the Commonwealth. Thomas Jessell FRS FMedSci cells. Sir Gregory Winter is a pioneer of protein Rosalind Smyth is a leader in research into engineering and is responsible for the development the health of children. As Professor of Paediatric of technologies used by the United States Food Medicine at the University of Liverpool, her and Drug Administration to approve the majority major programme of research into the disease of therapeutic monoclonal antibodies. A scientist, of bronchiolitis in infants is providing important inventor and entrepreneur, his work with Herman information about the immunopathology of Waldmann FMedSci led to the fi rst clinical use of this condition, which will be essential in the a genetically engineered therapeutic antibody, development of eff ective new treatments. Campath®, and his role in the founding and science Professor Smyth has a long-standing interest in of Cambridge Antibody Technology led to the fi rst the development of safe and eff ective medicines human therapeutic antibody, Humira®. Sir Gregory’s for children; she chairs the Commission on Human career is a powerful example of medical science Medicines’ Paediatric Expert Advisory Group and is combining with business acumen to benefi t Director of the UK Medicines for Children Research patients with innovative treatments. He is currently Network. Head of Division, Protein & Nucleic Acid Chemistry Department MRC Laboratory of Molecular Biology.

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 7 How we work

The Academy promotes discussion and provides advice on medical science in a variety of ways.

Throughout the year the Academy runs a number fashion. These fast-moving issues are addressed at of symposia, workshops and conferences, as well short-notice by mobilising small working groups for as world-renowned lectures. These events provide a one-off meeting to produce briefi ng notes. unique opportunities to bring together the leading The Academy also supports the career development fi gures in the medical community with relevant of high calibre young scientists in highly practical sectors of society to progress discussions on the ways through the work of two standing committees. important medical issues of our time. All of our projects are overseen or conducted by Each year the Academy carries out a number of a Fellow of the Academy, or senior public fi gure, in-depth, long term studies that culminate in the appointed by the Academy’s Council. The Council production of written reports representing the endorses all policy statements or recommendations discussions and conclusions of an expert study before publication. group. These reports and recommendations are submitted to specifi c individuals and organisations Projects may arise from recommendations from with appropriate follow up work undertaken the Academy’s Council and Fellowship, as well as to ensure a genuine impact on the nation’s in response to consultations from government, healthcare. Parliament and other relevant bodies. Many of our projects are undertaken in collaboration with The Academy responds to emerging and topical other UK and international bodies such as charities, issues with position papers, expert statements and research funders, or industry. comment released through the media in a timely

OFFICERS Treasurer (from Nov 05), Five Honorary Offi cers provide strategic Professor Ian Lauder FMedSci advice to the Academy: Dean, Leicester Warwick Medical School

President, Sir Keith Peters FRS PMedSci Registrar (to July 06), Emeritus Regius Professor of Physic in the School of Professor Patrick Vallance FMedSci Clinical Medicine, University of Cambridge Senior Vice President, Drug Discovery, GlaxoSmithKline Research and Development Vice-President, Sir John Skehel FRS FMedSci Former Director of the National Institute for Medical Registrar (from July 06), Research Professor Patrick Maxwell FMedSci Professor of Nephrology, Imperial College London Vice-President, Sir Michael Rutter CBE FRS FBA FMedSci Professor of Developmental Psychopathology, Kings COUNCIL College London A Council of 23 members including the fi ve Honorary Offi cers, all of whom are elected from Treasurer (to Nov 05), the Fellowship, oversees the work of the Academy. Sir Colin Dollery FMedSci Council may, from time to time, co-opt additional Senior Consultant, GlaxoSmithKline Pharmaceuticals Fellows to provide balance or expert advice.

8 THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 9 Progress through partnership

Opposite page The Academy believes it is essential that, whenever practical, the medical science clockwise from top left community speaks with a coordinated voice on key policy issues. We have forged Sir David King FRS Dr Tachi Yamada FMedSci productive relationships with a large number of individuals and organisations. Dr Tim Rolph This is what a few of our partners have said about working with the Academy. Dr Evan Harris MP The Rt Hon The Sir David King FRS Dr Tachi Yamada FMedSci Lord Jenkin of Roding FRS Chief Scientifi c Adviser to HM Government President, Global Health Program, Bill and Melinda Gates Foundation Professor Sally Davies FMedSci “As with the other National Academies, the government looks to the Academy of Medical “The Academy has a vital role to play in the Sciences for its expert and independent advice advancement of medical science. As a learned on pressing policy challenges. I am very pleased and neutral party it is able to articulate national to be working with the Academy in the area of priorities in research, foster collaborations brain science, addiction and drugs and await with between the private and public sectors and great anticipation the outcomes of the Academy’s most importantly provide unbiased analyses of deliberations on how to take forward policies and complex medical issues to government and the research in this important area. I am particularly general public. Over its short history the Academy grateful that the Academy will be breaking new has succeeded in all of these activities and gained ground by including within its study an extensive a global reputation for intelligence and impact.” programme of public dialogue and engagement supported by the DTI’s Sciencewise programme. Dr Tim Rolph I welcome the Academy’s commitment to this, and Pfi zer Global Research and Development look forward to strengthening the relationship.” “Pfi zer is a committed supporter of the Academy of Medical Sciences. It recognises the value of Professor Sally Davies FMedSci the Academy in bringing the pharmaceutical, Director General for Research and Development, biotechnology and biomedical research Department of Health community together, to work on areas of common “The Academy has over the last few years interest, for example, drug safety evaluation and developed a key role in British medicine and translational biomarkers to bridge from the lab to science. The Department of Health values both the man.” independence and high quality of advice given by the Academy and its fellowship. We look forward Dr Evan Harris MP to continued partnership working.” “It is very important that the scientifi c community, including the Academy, continues to make its The Rt Hon The Lord Jenkin of Roding FRS voice heard in public policy debates, especially “When the AMS was set up in 1998, I welcomed when we are facing a very worrying increase in it warmly. Medical science needed a distinctive the lobbying activity of NGOs who are not only voice to speak for research across the board, non-scientifi c but positively anti-scientifi c. In the unconstrained by the inevitable interests biomedical fi eld the stakes are very high. that colour the policies of other bodies in the fi eld. I have not been disappointed. Both from “The Academy of Medical Sciences has shown that my standpoint as the recent Chairman of the it can strike the right balance between timeliness Foundation for Science and Technology, and as a of its contributions and the evidential rigour Member of the House of Lords with an interest in of what it says. Politicians and the media need medical research, I have been very impressed by an eff ective source of advice and information the wisdom of the Academy’s pronouncements on drawn from those with expertise and experience a variety of matters; in particular, I welcomed the in evaluating a body of peer-reviewed scientifi c note of caution it has injected into the argument evidence. The Academy fulfi ls that role with about the proposed merger of the MRC’s activities energy.” and the NHS clinical research activities. We need that distinctive voice to be heard and to be listened to in places where decisions are taken.”

10 THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 11 Celebrating science

The Academy is passionate about celebrating the achievements of medical science. Through our prestigious award lectures, symposia and workshops the Academy communicates the latest biomedical research to a wide variety of audiences.

LECTURES Industry FORUM Medical Science Briefi ngs Jean Shanks Lecture Dr Robin Lovell-Badge FRS FMedSci 2004: Sir Philip Cohen FRS FRSE FMedSci Progress and prospects for stem cell research Protein kinase inhibitors; the major drugs of the Professor Staff ord Lightman FMedSci 21st century? and Professor Simon Wessely FMedSci 2005: Professor Kim Nasmyth FRS Is stress real? How do we inherit the right number of chromosomes? SYMPOSIA 2006: Dr Tachi Yamada FMedSci Public trust and biomedical research Challenges and opportunities Diseases of the developing world in global health The science of violence The Raymond and Beverly Sackler Lecture Experimental medicine 2005: Sir Aaron Klug OM FRS HonFMedSci Drug discovery Towards therapeutic applications of Cancer biomarkers and imaging engineered zinc fi nger proteins Valuing health research: assessing the benefi ts 2006: Sir Michael J. Berridge FRS FMedSci to society Calcium signalling in health and disease Legal symposium: personal data for public good Health, happiness and social status International Health Lecture 2004: Dr Bernard Moss Understanding Poxviruses: Jenner, WORKSHOPS genomics and genetic engineering Detection and identifi cation 2005: Sir Gustav Nossal AC CBE FAA FRS of infectious diseases Global health advances in a troubled Led by Sir John Skehel FRS FMedSci world: 2005 a turning point? Health service review Organised in collaboration with Industry FORUM Annual Lecture the NHS Confederation’s Health 2005: Professor Alex Markham FMedSci Services Research Network. Led by Cancer research in the UK: Professor Sir Andrew Haines FMedSci areas of optimism and concern Cooksey Review workshop 2006: Dr Tim Rolph Organised in collaboration with HM Treasury The human genome: realising and the Royal Society pharmaceutical opportunities

12 Our reports

RECENT REPORTS NPSA/COREC, Implementing the The Freedom to Succeed Recommendations of the Report on the Reports and consultation Chair Professor Keith Gull CBE FRS FMedSci Operation of the NHS responses are avalable on Chair Professor Patrick Vallance FMedSci the Academy website Microbial Challenge Studies www.acmedsci.ac.uk Chair Professor Richard Moxon FMedSci Department of Health, Best Research for Best Health: a new national health research strategy Safer Medicines Chair Sir Keith Peters FRS PM edSci Chair Dr Geoff rey Schild FMedSci Nuffi eld Council on Bioethics, Public Health: Testing Antibody Therapies ethical issues Chair Professor Patrick Vallance FMedSci Chair Professor Michael Rutter CBE FRS FMedSci Medical Research: assessing the benefi ts to society (a report of the UK Evaluation Forum) Chair Professor Martin Roland CBE FMedSci FUTURE REPORTS Brain Science, Addiction and Drugs Personal Data for Public Good: using health Chair Professor Sir Gabriel Horn FRS information in medical research Chair Professor Robert Souhami CBE FMedSci Pandemic Infl uenza Chair Sir John Skehel FRS FMedSci Systems Biology CONSULTATION RESPONSES Joint Chairs Sir Colin Dollery FMedSci Human Tissue Authority and Department of and Professor Richard Kitney FREng Health, Human Tissue Act Chair Professor Sir Nicholas Wright FMedSci The Use of Non-Human Primates in Medical Research Research Assessment Exercise 2008: Panel Criteria Chair Professor Sir David Weatherall FRS FMedSci and Methods Chair Professor Peter Rigby FMedSci Non-experimental Methods Chair Sir Michael Rutter FRS FBA FMedSci Department of Health consultation on the Human Fertilisation and Embryology Act Chair Dr Anne McLaren DBE FRS FMedSci

The articles on the following pages highlight some of our recent reports and work programmes

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 13 Advancing medical science and infl uencing policy

Linda Partridge discusses how the work of Academy Fellows is transforming our understanding of the ageing process.

The greatest challenge to medical scientists in the We are coming to understand that the processes new century is to achieve a greater understanding which may signifi cantly aff ect our health in old age of the ageing process and the diseases of old may have their origins very early in our lives – even age. Greater longevity must be matched with before birth. Indeed, a good way of improving an increased quality of life in old age, not least if your quality of life in old age may be to choose healthcare systems are to survive the increasing your parents carefully and look after your mother’s demands that an elderly population places upon health before you were born! We are increasingly them. Research into ageing makes very good understanding the long-term eff ects that smoking Professor Linda Partridge economic sense. and high-calorie diets have on mothers and their CBE FRS FRSE FMedSci unborn children. Linda Partridge is Academy Fellows are involved in a number of major Professorial Fellow and research projects based at some of the UK’s leading The work of my team at University College London Weldon Professor of centres for the study of ageing. Our work seeks to is concentrating on building our understanding of Biometry in the Department ensure that we don’t just live longer – but that we the ageing process at the genetic level. Studies on of Biology at University live healthier. the genes of fi rst nematode worms, then the fruit fl y, College London and now rodents are suggesting – remarkably – that At the start of the last century, the average life mutations in single genes that encode components expectancy in the UK was 47. By the beginning of of the insulin and insulin-like growth factor signalling the new millennium, that had risen to 76 for men pathways seem to reduce the amount of ageing- and 81 for women. For both genders, life expectancy related damage that occurs in cells and tissues and to has risen by more than fi ve years in the last 20. By extend healthy life-span. 2100, studies suggest that most human beings in the developed world can expect to live to 100. While this research may increase our life-span, its true value lies in the way it is helping us to understand That these fi gures have risen so remarkably is a great how ageing acts as a risk factor for so many of the tribute to the achievements of medical science in major killers: heart disease, cancer and dementia. the twentieth century. But society’s successes in Extension of lifespan by alterations to insulin signalling tackling infectious diseases have in turn uncovered seems to be accompanied by a delay in the onset a range of age-related chronic diseases that were far of diverse ageing-related diseases. If many of the less of an issue for our great-grandparents. illnesses of old age have their basis in shared features It is also interesting to note that, despite the glaring of the normal ageing process, it may also be possible national demographic, not all medical schools have to develop a common cure. The exciting next stage an academic department for the medicine of ageing. will be to see how these fi ndings in animals translate I never cease to be amazed by how few trainee to humans. GPs go through a geriatric rotation, even though, The Academy is working to move research into in many cases, the majority of their patients will be ageing further up the government’s agenda, and to elderly . increase the understanding of policy makers. In our We know that, as we get older, a bewildering response to a House Lords Science and Technology number of changes take place in the body, with Select Committee Inquiry into scientifi c aspects of proteins, DNA and lipids accumulating multiple ageing, the Academy called for a joined-up national forms of damage. Such damage can lead to programme that co-ordinates both funding and pathology in almost all tissues, and diff erent types research strategy into healthy ageing. We also of pathology in any one tissue. For most of the suggested ways in which clinical trials and population twentieth century, ageing was viewed not as one based studies might be improved. The NHS off ers very process, but as lots of processes with many diff erent great opportunities for research into aging that must causes. be harnessed.

14 Professor Linda Partridge’s laboratory work is seeking to understand the mechanisms of ageing.

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 15 Building trust in science

Robert Souhami highlights the Academy’s ongoing role in the regulation of medical research.

The UK has long been a world leader in population proposals of this type. Other bodies issue guidance based research. This form of research often uses data even though they are not directly involved in the in health records and databases, usually collected assessment of research proposals. for clinical care. It is sometimes the only means of Concerns that research was being impeded led the obtaining data on treatment outcomes, potential Academy to establish a working group to inquire into environmental causes of disease and on social and the present position and to make recommendations. societal factors in health. In recent years, the UK Personal Data for Public Good: using health information has seen a change in attitudes towards the use in medical research (June 2006) has helped to infl uence Professor Robert Souhami of personal data, and medical research has been the climate of opinion about the regulation of this CBE FMedSci aff ected by new legislation designed to protect research. Professor Souhami was privacy and confi dentiality. Director of Clinical Research The working group recommended that the law and Training at Cancer Wherever possible such data are only used in medical should be regarded by those involved in research Research UK. research with the consent of patients or in fully governance as permissive of the use of personal data anonymised form. Obtaining consent may be diffi cult without consent or anonymisation, provided that the or impossible because the data may have been risks were small and in proportion to the likely benefi t. collected long ago and patients moved on. Complete There should be a simplifi ed scheme of assessment of anonymisation sometimes leads to loss of important research proposals with clear guidance on the approval information and the ability to cross-check data. process. Good practice guidance should be developed In spite of the exceptional advantages the NHS concerning the need for consent, anonymisation and provides in terms of population coverage, the data security. PIAG should change the way in which UK has disadvantaged itself by a combination its committee operates to assist research, without of conservative interpretation of the new laws, compromising the public interest. There should be and by complexity and inconsistency in research research on specifi c aspects of public perception of governance. In fact, the law specifi cally allows for research using personal data, using representative research using personal data without consent or full populations in well-designed studies. The UK health anonymisation, provided it is demonstrably in the departments should develop public awareness public interest and that the risks to individuals are programmes concerning the purpose and value of low. this research within the NHS. Finally, those responsible for the establishment of electronic healthcare records, Public perception of the balance between risk and which off er such promise for population research, benefi t is largely unresearched. There is likely to be should work with the research community to ensure a considerable diff erence in sensitivity concerning research needs are incorporated in the programme. the research use of data regarding hypertension, compared with data about sexually transmitted In making these recommendations, the working disease. We need to know more, and to avoid group suggested mechanisms whereby they might assumptions about what the general public, patients be put into eff ect. Progress has followed. A research and their relatives think. advisory committee has been established to assist the development of electronic health records. The UK At present there are numerous regulatory bodies that Clinical Research Collaboration has accepted the task may comment on research proposals. These are the of developing good practice guidance by its members. R&D offi ces of hospital and Primary Care Trusts, the Major research funders have agreed to fi nance research Offi ce of the Information Commissioner and Ethics into public perception. The Academy will continue to Committees. There is also the Patient Information work constructively with its partners to support this Advisory Group (PIAG) established under the Health research ensuring that it is conducted to the highest and Social Care Act specifi cally to advise on research standards, with the full participation of the public.

16 Professor Robert Souhami highlights how the storage and use of personal medical data is a key issue of trust between researchers and the public.

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 17 Working in partnership with industry

Patrick Vallance describes how representatives of business and academia worked together to tackle the challenge of developing safer medicines.

Developing drugs that are both safe and eff ective The initial report, which was a large undertaking is an ongoing challenge; drugs that bring genuine involving many sub-groups working over many benefi t will always carry some degree of risk and months, has triggered a number of specifi c actions society is becoming increasingly risk averse. Couple that should benefi t patients. However, this mammoth this with the feeling that the science of drug safety undertaking was soon followed by a real safety has not always kept pace with advances in other crisis that need an unusual Academy response – the areas of biomedical science and it seems that events at Northwick Park involving a super-agonist change is inevitable. It was with this in mind that the monoclocal antibody. The Academy was able to Professor Patrick Vallance Academy’s Industry Forum, which brings together draw together a group of experts, some of whom FMedSci leading scientists from academic medicine, the had been involved in the Safer Medicines report, who Patrick Vallance is pharmaceutical industry and regulatory and funding were expert in antibodies and immune responses. Senior Vice President, bodies, undertook a study into safer medicines, The group’s remit was: to consider the potential Drug Discovery at attempting to explain the risks involved and role of antibody therapies as treatments; to identify GlaxoSmithKline, having approaches to minimise them. potential safety hazards unique to the assessment been head of the Division of antibody therapy; and to provide a framework for of Medicine at UCL until The Academy’s Industry Forum provided instant earlier this year. He served further steps to ensure the safe introduction of new access to a wide range of expertise and diff erent as Registrar of the Academy antibody therapies. It was interesting to see how the perspectives ranging from molecular toxicology from 2003 until 2006. Academy was able to get the right group of scientists through epidemiology to the use of electronic together at short notice and produce a concise, clear patient records to monitor drug eff ects. The working and constructive report in record time. This report group remit was to identify practical measures to made a signifi cant contribution to the Medicines and improve drug safety and where possible achieve Healthcare products Regulatory Agency inquiry and consensus around the scientifi c priorities. In drafting highlights the Academy’s ongoing commitment to the report a recurring theme was partnerships the development of safer medicines. – between industry, academia, regulatory bodies and the public. It was clear that all parties need to Underlying all of this work is a need to foster greater be engaged if we are to move to the more rapid public engagement on drug safety and to share introduction of eff ective and safe medicines. understanding of the risks, benefi ts and assumptions surrounding drug development and delivery. Industry The Safer Medicines (November 2005) report and academia should recognise the need to involve, highlighted pre-competitive sharing of information inform and engage the public. How we present as a signifi cant area to improve drug safety. Much information is vital and we should strive towards of the preclinical and clinical safety data could some standardised way of presenting the data. be shared to create a very signifi cant resource for predictive toxicology. This is a huge task, and one Our Safer Medicines report is one step in a longer- that will require more than just UK Industry and term strategy; the object is to advance the progress academia forming partnerships, and there was of safe and eff ective new drugs for the benefi t of a clear message that we need to engage with all patients. The Academy will continue to build our sister academies to push things forward on links with interested parties in taking forward the an international front. At the population level it present recommendations and to support, where became clear that the electronic patient record appropriate, the initiatives of other bodies. could become one of the major tools for monitoring drug safety and that the UK has a potential major advantage in this respect. We must use our electronic health system for patient safety analysis and ensure that a properly constructed electronic patient records database is enabled for research use.

18 Professor Patrick Vallance’s career spans industry and academia. In each, substantial intellectual and fi nancial resources are committed to drug safety.

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 19 The impact of research

Martin Roland argues we need to demonstrate just how medical science makes a measurable diff erence to the economy and society.

How do we measure the impact of medical research The Forum identifi ed a need for further work on the on the economy and society? For a profession totally economic benefi ts of medical research, including dependent on accurate measurement at the micro- some areas for methodological improvements. level, we are surprisingly poor at calibrating our Overall, the Forum concluded that there were clear broader contribution. opportunities for the UK research community to develop better evaluation methods, to encourage Government fi gures testify to both the excellence and better consistency in evaluation practices and to effi ciency of UK medical research. Indeed, medical demonstrate research achievements more actively. Professor Martin Roland research is increasingly seen as playing a key role in CBE, FMedSci improving the nation’s health and wealth. However, A key question addressed by the Forum was the role of is Director of the National alongside recent increases in research funding, there the scientifi c community in promoting research. Some Primary Care Research is a growing need to demonstrate the wide range argue that researchers need to be much more up front and Development Centre of socio-economic benefi ts that result from this in promoting their work. Scientists are regarded as and Professor of General investment. doing a particularly poor job in promoting what they Practice at the University of do, in stark contrast to those from many other areas Despite signifi cant activity in quantifying the inputs Manchester. of the economy. This made uncomfortable reading and outputs of research, there are few examples for some, who felt that the job of scientists was to where the broader outcomes and impact of research advance knowledge, not to be lobbyists. have been assessed, particularly in terms of the socio- economic benefi ts. The UK Evaluation Forum was set The Evaluation Forum concluded with four main up by the Academy of Medical Sciences to address this. recommendations ● The research community should consider how it The Forum included representatives from a range can better demonstrate the value and benefi ts of of UK funding organisations, including the public, medical research to all its stakeholders, through charitable, academic and commercial sectors. It improved use of existing evaluation tools, greater explored how diff erent organisations assess the sharing of good practice and the development of outputs and outcomes of their investment in research, new approaches. share good practice and knowledge about research ● UK research funders should work together to evaluation methods, and identifi ed opportunities for develop an evidence base to demonstrate coordinating UK activity in the area. the impact of research. This should include The Forum concluded that there was no one ‘best’ identifying opportunities for greater consistency method of evaluating research. Rather, various of data collection and analysis across funding evaluation methods are complementary and diff erent agencies. organisations and their stakeholders need diff erent ● Research funders should identify and fund further evaluation methods at diff erent times. Similarly, research into evaluation methods with a rigour research funders need to adopt evaluation methods and quality equivalent to other research fi elds. In that are appropriate for their research; these need to particular, UK research funders should support take account of the often long, risky and incremental research to assess the economic impact of UK nature of medical research, and to recognise the value medical research, which should include a critical of negative fi ndings in adding to overall knowledge. analysis of existing economic approaches. Some economic approaches to quantifying the ● The research community should consider how benefi ts of research produce startling results. For it can stimulate a more active and informed example, the American ‘Exceptional Returns’ study dialogue with policy makers and the public (Funding First 2000) suggested that there has been a about the achievements, applications and 20:1 return on investment in cardiovascular disease broader societal implications of medical research. research between 1972 and 1992, with an overall Researchers urgently need to become more benefi t to the US economy from cardiovascular active in this debate. disease research of $1.5 trillion per year. 20 GP’s work at the forefront of communicating the impacts of research in their daily dealings with patients.

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 21 Creating the next generation of medical scientists

Keith Gull shows how the Academy is helping to develop the career structures that will maintain and support world class researchers.

The Academy retains two standing committees structures of existing and new fellowship programmes in careers: one on clinical careers is led by John being developed by the MRC, Cancer Research UK, the Tooke, Dean of the Peninsula Medical School; and Wellcome Trust and other agencies. another seeking ways to infl uence and improve There is often still a lack of connectivity between research non-clinical career structures that I chair. As a matter fellows and industry. It is vital that young scientists have of policy, both groups also include young scientists an informed view of the careers that exist in big pharma and representatives of partner organisations and and smaller biotech companies and the benefi ts of industry. Both teams have had excellent support collaboration between the academic and industrial Professor Keith Gull from the broader Academy Fellowship and, crucially, sectors. Assisting individual scientists to reach their CBE FRS FMedSci each is making a signifi cant diff erence. is Wellcome Trust Principal potential and enjoy fulfi lling careers has to be central Research Fellow and Professor In the clinical area the study led by John Saville in to the Academy’s aims. Achieving this will contribute to of Molecular Microbiology at 2000 set out how the UK could create a new cadre the Chancellor’s exciting ten year vision for science and the University of Oxford. The of clinical academics and ensure the training of buttress the retention of UK industry’s competitive edge Academy’s website dedicated individual clinicians in their particular specialism and prosperity. to providing information as they undertake post-doctoral research. In the about academic careers Another goal, at a time when women form the majority wake of the Savill Report, further studies such as can be visited at of those embarking on research careers, will be to Strengthening Clinical Research (October 2003), and www.academicmedicine.ac.uk develop the policies and fl exible career structures that the report of the Academic Careers Sub-Committee are right for women in science. of Modernising Medical Careers and the UKCRC (March 2005) have addressed the needs of aspiring Most organisations are still not good enough at tracking clinical academics at diff ering career stages. the career progression of those whom they fund. Too often, we simply don’t know if particular training and The Academy’s 2004 review highlighted the success development systems are working eff ectively – or of our Clinician Scientist Fellowships. Alongside this, even how we go about measuring success. Moreover, our Mentoring Programme is now setting a gold in an area where career progression is (rightly) standard in the career development of clinician highly competitive, I worry that we still do not really scientists. There are now around 100 partnerships understand the shape of the career pyramid. Put simply, in place with Academy Fellows mentoring those how many medical and biomedical scientists do we involved in fi ve year clinician scientist fellowships. need to enter the bottom of the pyramid in order to An independent review conducted in July 2006 achieve excellence in suffi cient numbers and in the right by The National Coordinating Centre for Research specialisms as people approach the top? Capacity Development gave the programme top marks for quality and relevance. Of course, not everyone will reach the top of the academic pyramid, and some will choose not to The Academy’s work is also having signifi cant continue research. In these cases it is important that infl uence in shaping career structures for those we ensure that their entry into careers in management, embarking on careers in the non-clinical area. teaching, administration, government agencies, fi nance The Academy’s study of non-clinical biomedical (and even politics!) occurs as a positive exit from fellowships, Freedom to Succeed, published in 2005 academic research. has had considerable infl uence in developing good practice. An increasing number of organisations The UK will not retain its world class position in medical now enter into contractual arrangements with science unless we create the sustainable career researchers at the conclusion of their fellowship structures that attract and retain scientists of the very programmes and we will continue to press for the highest calibre. The Academy of Medical Sciences spread of this good practice. Many of the issues and is playing a central role in building this pipeline of proposals of this report are now refl ected in the excellence, at a national and a local level.

22 Dr Alison Simmons, Weatherall Institute of Molecular Medicine, Oxford and Professor Brigitte Askonas FRS FMedSci, Visiting Professor of Biology, Imperial College London, one of around 100 mentor pairs set up by the Academy.

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 23 Financial information

In the summer of 2004 Lord Warner announced Expenditure analysis 2005/06 that the Department of Health would provide grant-in-aid of £1.75 million to meet the core Research Fellowships running costs of the Academy over the next fi ve years. This grant, allied to the support of our Medical Fellows and the other very generous donations science policy we continue to receive, has enabled us to 61% 15% plan for the future and increase activities as Medical science demonstrated here. 5% & industry 5% Education 8% & training

Income and expenditure over 4 years 5% Academy Fellows 1% Total Income Total Expenditure

Governance

Cost of generating funds £2,319,158 Statement of reserves At 31 March 2006 total reserves were £2.11 million with £429,000 in the General Fund; £625,000 in the

£1,847,008 Relocation Fund; £856,000 in various restricted funds

£1,773,237 and £200,000 as permanent endowment.

£1,559,386 The reserves policy, approved by Council in 2006, £1,428,795 requires that an amount representing 6 month’s expenditure on core activities be retained in the General Fund. Any excess of the target level is transferred to a designated Relocation Fund, set up £886,309 in response to continuing pressure on offi ce space at £713,450 10 Carlton House Terrace. Other balances held in the restricted and permanent endowment funds are not

£394,335 for the general purposes of the Academy but are held on the specifi c direction of the donors.

To view detailed audited accounts visit www.acmedsci.ac.uk 31 March 2003 31 March 2004 31 March 2005 31 March 2006 31 March

24 The Academy offi ce

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Photography: Phil Photography: Sayer e: [email protected] t: 020 7969 5234 e: [email protected] or [email protected] e: [email protected] Ms Joanna Baker Mr Laurie Smith INDUSTRY FORUM Fellowship Offi cer Senior Policy Offi cer Ms Jenny Steere t: 020 7969 5233 t: 020 7969 5289 Forum Programme Offi cer

. e: [email protected] e: [email protected] t: 020 7969 5209 Design: Richard Boxall Design Associates e: [email protected] FINANCE Dr Robert Frost Ms Liz Holder Policy Offi cer Finance Offi cer t: 020 7969 5284 t: 020 7969 5297 e: [email protected] e: [email protected] . Printed stock in England by Quadra Colour on recyled

THE ACADEMY OF MEDICAL SCIENCES REVIEW 2006 25 Donors Industry FORUM members Acambis plc Advent Venture Partners Ardana Bioscience Limited Ardana Bioscience Ltd Association of British Neurologists Association of British Health Care Industries AstraZeneca Association of the British Pharmaceutical Industries Aventis Pasteur Association of Medical Research Charities Cancer Research UK Astellas Chiron Vaccines Astex Technology Ltd Department of Health AstraZeneca Plc GlaxoSmithKline BioIndustry Association National Radiological Protection Board Biotechnology and Biological Sciences Research Council St John’s College, Cambridge British Heart Foundation The Biochemical Society British In Vitro Diagnostics Association The British Academy BUPA The British Council Cambridge Antibody Technology The Dixons Foundation Cancer Research UK The Foulkes Foundation Engineering and Physical Sciences Research Council The Jean Shanks Foundation F.Hoff mann.La-Roche Ltd The Kohn Foundation GE Healthcare The Medical Research Council GlaxoSmithKline Plc The Primary Immunodefi ciency Health Protection Agency Association Integrated Medicines Limited The Raymond & Beverly Sackler Medical Research Council Foundation Merck Sharp & Dohme Limited The Rayne Foundation Pfi zer Ltd The Society for Endocrinology Renovo Ltd The Wellcome Trust Veloscient Ltd The Welton Foundation Wellcome Trust University Hospitals Association Wyeth Plc Wyeth and the Academy Fellowship

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